Nursing at the Policy Table: Are we at the Table or on the Menu?
by Patrick Chiu MPH, BScN, RN
Nursing has a long and proud history of promoting health, preventing disease and injury, and addressing the social determinants of health that are so influential to the health and well-being of individuals and communities. However, as we reflect on the past and present, and recognize the tremendous history and contributions that nursing has and will continue to have on health outcomes, patient satisfaction and cost-effectiveness within the healthcare system, why is it that in 2017, nursing across the world continues to struggle with the same issue of ‘being on the menu, and not at the table’?
Last month, I had the absolute honor and privilege of being selected to attend the International Council of Nurses’ Global Nursing Policy Leadership Institute (GNPLI), alongside 26 global nurse leaders, in Geneva, Switzerland. A rare opportunity, I found myself learning and building relationships with some of the most inspiring, determined, articulate and passionate nurse leaders from 19 countries that represented all of the World Health Organization’s regions.
The theme of the residential workshop was to ‘empower, educate, mentor, and develop.’ This intensive week was filled with learning, discussions, and networking with global nurse leaders. The goal of the program was to help enhance our effectiveness in bringing about policy changes that lead to health improvement, by increasing our political and policy competence, specifically within the context of the United Nations Sustainable Development Goals. Speaking with global nurse leaders, it was clear that the inextricable linkages that we have with our communities positions nurses to be clear leaders in influencing healthy public policy. In fact, we could successfully argue that there is no other health profession that aligns more strongly with the principles and values of patient-centred care.
As 27 nurses coming from differing political, social and economic contexts, there was no doubt that we were all different. However, our collective vision, determination, and passion in improving the health and well-being of our communities and strengthening health systems was a true testament to the philosophy of the nursing profession. The belief that nursing should be at the policy table, could not be disputed. However, it was somewhat ironic that while we all held such a strong belief, the top area for improvement among global nurse leaders was, in fact, policy and political skill.
While nurses hold significant expertise in nursing, health and healthcare, our challenges with successfully influencing policy can often be attributed to a lack of understanding of the political context, process, and actors in order to advance a policy agenda. It’s not enough to assume that because of the nature of our practice and the expertise gained from our work that we’ll be invited to the table. In order to be involved in agenda setting, policy formulation, policy implementation and policy review, we need to understand power, politics and policy. Specifically, some of the take home messages that resonated with me include:
- Look outward, and set agendas for a broad range of health and social policy issues. It is critical that we frame issues in the interest of individuals, communities and the healthcare system, with nursing as a solution. If nursing positions itself as the solution rather than the issue, we will quickly move from being on the menu to being at the table. For example, a report developed in 2016 by the All- Party Parliamentary Group on Global health (APPG) calls for raising the profile of nursing globally and to enable nurses to work to full scope in order to achieve universal health coverage. It does so by eloquently framing how supporting and developing nursing has a broader triple impact of better health, greater gender equality and stronger economies.
- Learn and be familiar with political language. Yes, we’re great at using our own healthcare and nursing jargon, and often times, we quite like it. However, if we aren’t able to craft clear concise messages, and communicate effectively with our target audience (many of which are politicians and policy makers), we only end up speaking to ourselves. Achieving political sophistication involves learning and utilizing language and rhetoric commonly used in policy debates.
- Build Coalitions within and outside of nursing. In order for nursing to successfully influence policy, we need to collaborate and bring forward one strong unified message in everything that we do. Once this is achieved, we need to build coalitions with stakeholders outside of nursing by understanding their influence/power, interest, expectations, values, and position. If as nurses, we understand that health is impacted by a range of structural and social determinants, we should also come to the realization that collaboration beyond nursing is absolutely vital. Nurses should absolutely be taking the lead in addressing health and social policy issues, but this cannot be done without the support of politicians, policy-makers and health leaders outside of nursing.
- Build nursing policy leadership at all levels. Nursing is so much more than providing care at the bedside. It’s a political act. The only way to continue to engage nurses in policy is for nursing education and professional associations to be champions in supporting nurses in policy, and to develop the next generation of nursing policy leaders. We need to continue to prove that nursing’s contributions go far beyond the walls of healthcare facilities or individuals’ homes, and that the profession does in fact, have a major role to play in achieving the sustainable development goals.
We see examples of nurses being “edge-runners” on a daily basis, seeking innovative ways to bring new thinking and methods to a wide range of health challenges that confront us every day. Recently, WHO Director General, Dr.Tedros Adhanom tweeted “It’s a must to hear the voice of nurses. A force to reckon with…”, and I couldn’t agree more. Today, more than ever, we have a real opportunity to ensure that nursing is at the policy table locally, nationally and globally. But expertise in nursing is not enough. We need to think broadly, be experts in the political process and context, learn the language, and build coalitions. Only until then, will we find ourselves consistently sitting at the table, and not waiting to be selected from the menu.
ABOUT PATRICK CHIU, RN
Patrick holds a BScN from McMaster University and Master of Public Health (MPH), with a focus in population health from Simon Fraser University. He has experience working in several acute care areas including emergency, critical care, and medical/surgical nursing. Patrick is committed to working collaboratively with ARNBC’s membership and stakeholders to advance the nursing profession, and to influence health and nursing policy. Patrick is ARNBC's Policy Initiatives Lead.
Thanks for sharing this, Patrick. You're absolutely right. We have the ability to influence social policy using our collective nursing voice.. I think often, as nurses, we struggle with feeling confident using political language and advocating for policy changes. The best way to build this confidence is to practice---can you point to some resources we can access through ARNBC to develop our political potential?
Thanks for your comment, Sherri. ARNBC currently delivers 'issues workshops' and 'briefing note workshops' to teach students and nurses how to identify key issues, develop messaging, and develop policy tools such as issue notes, briefing documents, etc. to influence policy. More information can be found here: https://www.arnbc.ca/programs-and-services/workshops-and-webinars/issues-workshop.php
The issue briefs, position statements, and other resources under our 'policy and advocacy' tab on the website house some of the policy tools that ARNBC has developed to respond to key nursing and health policy issues. Any nurse can read through these, provide feedback, and utilize them. There are many ways to build capacity in policy development. One key way is to get involved! Participate in consultations, put your name forward for a committee or council, raise an issue through the ARNBC blog, or submit an issue through our issues report form. Policy development is not a linear and straightforward process, and getting involved will allow nurses to learn about the complexities and gain experience at the same time. One of ARNBC's main goals is to ensure that nurses have the opportunity to influence nursing and health policy at the provincial and national level. I would encourage any nurse who is interested to get in touch with the Association!
As someone who is doing graduate work in comparative policy and organizational behavior and teaching in healthcare policy, I think this is very very true.
I do however question when and how nurses are 'educated' in the political process. This is not an easy topic to 'pick' up and unless there is an interest I don't see many people willing to take on this process.
I think it would be great to focus on this skill development but I think it is a process.
I would love to be involved in any development process! d
Thank you, Patrick, for this blog post following your recent participation in the ICN’s Global Nursing Policy Leadership Institute. It was so interesting to read about your experience and to review your four key messages.
You referred to the Triple Impact Report of the All-Party Parliamentary Group on Global Health (APPG). During the ICN Congress in Barcelona in May 2017, Lord Nigel Crisp, co-chair of the APPG, spoke enthusiastically about a new initiative arising from the report. Plans have been announced for a global campaign - to be known as Nursing Now! - with the purpose of raising the profile of nursing globally and demonstrating the profession’s contribution to Universal Health Coverage, women’s empowerment and economic development. Specific plans are under development in preparation for the official launch early in 2018.
The campaign’s intent is to increase the capacity of nursing to influence policy and to focus on nurse leadership within countries and organizations. The work will be carried out in partnership with the International Council of Nurses, the World Health Organization, the Burdett Trust in the UK and others. Nurses are invited to sign up for monthly updates with details about planned activities in advance of the launch: http://www.appg-globalhealth.org.uk/
I plan to follow the Nursing Now! campaign as a way to gain a deeper understanding of policy processes in a global context and to learn about effective strategies for action. I see its potential to inspire collective action through our national nursing associations and global networks to ensure that nurses are ‘at the table’ in policy development to improve health.